TCM For Irritable Bowel Syndrome

Chinese Medicine for Irritable Bowel Syndrome    

By Adina Stanescu, AC, DCHM

This condition, known commonly as IBS, accounts for up to 50% of visits to gastroenterologists in North America. Its prevalence in the general population is quite high, between 15 and 22%, with women more often affected than men. In the past it was also called spastic colon or nervous colon, names which give  us some instant clues about the disorder’s characteristics.

In fact, I think of IBS as one of the conditions that illustrate very well the mind body connection. There is a higher incidence of anxiety disorders, major depression or a history of abuse in IBS sufferers than the general population. As many as 77% of those surveyed reported onset of symptoms after a major mental health challenge. A chronic psychological state of vigilance and low-level anxiety is a common co-factor.

The most common symptoms of IBS are abdominal pain, bloating (especially in the afternoon), diarrhea, constipation, or alternation between diarrhea and constipation. Other symptoms may include gurgling, excessive gas, urinary urgency and, in women, PMS. Sometimes the abdominal pain may radiate to the shoulder or chest, groin or rectal area, and this may worry sufferers that they have another, more serious problem. It is actually part of the symptom complex of IBS, and usually a result of trapped gas pockets.

In fact, patients need to be assured that IBS is only a functional problem, not an organic one and carries no risk of subsequently developing cancer or any of the more serious, inflammatory bowel diseases such as Crohn’s or colitis. In IBS, the smooth muscles of the intestines are hyper-reactive and may easily spasm at the slightest provocation and lead to pain. This hyper-reactivity may also increase the transit time of food through the intestines, causing diarrhea or bowel movements immediately after eating.

THE TCM VIEW OF IBS

Traditional Chinese Medicine (TCM) has described the symptom complex of IBS in thousand year old medical texts, and offers excellent treatment for it. It is interesting that TCM has always acknowledged a mental/emotional component to this condition. The symptoms of IBS are commonly worsened by emotionally stressful situations, which affect the enteric nervous system, i.e. the nervous system of the gut, also known as the “abdominal brain”. Scientists are now beginning to pay close attention to this previously neglected system in order to better understand illnesses like IBS, and what appears to be a surprisingly strong brain-gut connection. I like to describe TCM treatment for this condition as a process of “untying the knots”: the emotional knots that have caused the condition, as well as the spastic knots of the bowel itself. While this therapeutic strategy is used in most cases of IBS, there are other presentations to be considered, below.

STAGNANT QI TYPE 

In this pattern, emotional constraint, tension, irritability and depression play a large part. Symptoms worsen with stress or in the premenstrual period. There is abdominal pain and bloating, frequent erratic stools that are either thin and loose or dry pellets, frequent sighing, poor sleep, and anxiety. There may be considerable cramping and urgency preceding the stool. The herbal formula used is often a variant of the famous Xiao Yao Wan, which translates as “Free and Easy Wanderer.” If the emotional state can be made “free and easy”, digestive symptoms will lessen considerably or disappear. A wonderful example of mind body treatment!

Dietary recommendations include avoidance of alcohol, spicy food, excessive caffeine and meats, all of which may worsen the already over-stimulated mental state.

Additionally, such patients will greatly benefit from concurrent counselling or relaxation programs.

COLD TYPE 

This pattern manifests with symptoms that are aggravated not so much by emotions, but by cold, i.e. cold or raw foods, as well as when greatly fatigued. There is much more likely to be diarrhea here than constipation, especially in the early morning, and presenting with undigested food in the stool. Gurgling is often a feature, as well as a desire to keep the abdomen warm, or to hold it for comfort. This is an easy pattern to treat, and the herbs are quite pleasant tasting, as they include warming spices such as nutmeg, ginger and cinnamon. Avoidance of raw fruit and vegetables, as well as ice cold drinks is useful during treatment, and recommended only in small amounts thereafter.

DEFICIENT TYPE

If symptoms persist, as they often do with IBS, for many years, or if the person is constitutionally on the frail side, the digestive organs may be weak and unable to properly perform their functions. Aside from the classic symptoms of IBS already described, there may be pronounced fatigue, poor appetite and difficulty concentrating.

Strong tonics such as Ginseng, Atractylodis or Codonopsis root, as well as herbs which promote digestive enzymes, such as sprouted barley and hawthorn fruit are given. The patient is asked to eat regular meals, with plenty of protein and lightly steamed rather than raw food.

THE ROLE OF DIET

While certain dietary recommendations are made in each case, as above, I believe that too great a concern with food is actually quite harmful in the treatment of this condition. As mentioned, a psychological state of “vigilance” and anxiety is quite common with IBS. Many people become concerned that it is various food sensitivities or food allergies that cause their symptoms, and become very tense about eating the right or wrong kind of foods.

Any food allergy that has been demonstrated through medical testing and repeated reaction (hives, swollen lips and mouth, nausea, vomiting, diarrhea) should indeed be avoided. But those are symptoms typical of an immune-mediated, histamine reaction, not the digestive dysfunction symptoms of IBS.

Food sensitivity, on the other hand, tends to give rise to mild, vague and inconsistent symptoms – a sort of now you have it now you don’t situation. I believe this to be a consequence of the IBS, not its cause, and advise patients not to worry too much about them. Once treatment normalizes GI function, food sensitivities will decrease or disappear.

Adina Stanescu C.Ac. DCHM runs THE TCM CLINIC in Toronto. She can be reached at 416-968-3308 or through www.thetcmclinic.com.